Objective: To observe the changes of arm equilibrium pressure (P(arm)) in different occlusion time, the reference range of P(arm) in hemodynamic stable patients, and to explore the relationship between P(arm) and systemic hemodynamic parameters. Methods: Mechanically ventilated postoperative abdominal surgery patients who admitted to ICU with stable hemodynamic status were enrolled. After hemodynamic data were recorded, arm stop-flow maneuvers were performed to measure P(arm). At 10, 20, 30, 40, 50, 60 seconds after occlusion, arterial pressure were measured twice within 5 minutes and recorded as the average value. Results: Thirty patients were included. The P(arm) decreased gradually with the prolongation of the occlusion time.The value was not stable within 60 s, but the reducing extent was not obvious after 40s. The 95% reference range of P(arm) 30 s was 23-44 mmHg(1 mmHg=0.133 kPa) and P(arm) 60 s was 19-35 mmHg. P(arm) at 30 s and 60 s were positively correlated with systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, central venous pressure (all P<0.001), but not heart rate and pulse pressure. Linear regression analysis showed that P(arm) at 10 s, 20 s, 30 s only had linear correlation with diastolic arterial pressure (10 s, β=0.504, P=0.001; 20 s, β=0.297, P=0.005; 30 s, β=0.231, P=0.015), and P(arm) at 40 s, 50 s, 60 s were linear correlation with diastolic arterial pressure (40 s, β=0.220, P=0.004; 50 s, β=0.210, P=0.004; 60 s, β=0.213, P=0.004) and central venous pressure (40 s, β=0.516, P=0.018; 50 s, β=0.513, P=0.01; 60 s, β=0.472, P=0.023). Conclusion: In mechanically ventilated postoperative abdominal surgery patients with stable hemodynamic status, P(arm) decreases when occlusion time is prolonged, which is not stable within 60 s occlusion. Arterial blood pressure and central venous pressure are positively correlated with P(arm).
目的： 探讨不同阻断血流时间对前臂平衡压(P(arm))的影响及与全身血流动力学指标的相关性。 方法： 选2016年1—6月北京清华长庚医院全身麻醉腹部手术术后入ICU的机械通气且血流动力学稳定者，采用前臂血流阻断法，在阻断前臂血流后10、20、30、40、50、60 s时记录桡动脉内压力数值，待压力数值稳定后即为P(arm)，分析P(arm)与血流动力学指标的相关性。 结果： 共入选30例行择期全身麻醉下肝胆外科手术术后入ICU机械通气患者，前臂血流阻断10 s P(arm)为(52.4±9.1) mmHg(1 mmHg＝0.133 kPa)，阻断20 s为(41.6±7.7) mmHg，阻断30 s为(33.6±5.3) mmHg，阻断40 s为(30.4±4.5) mmHg，阻断50 s为(28.5±4.3) mmHg，阻断60 s为(27.0±4.3) mmHg(P<0.001)，P(arm)随着阻断时间的延长压力呈先快后慢逐渐降低，但在60 s内未出现稳定值。前臂血流阻断30 s时P(arm)的95%参考范围是23～44 mmHg，阻断60 s时P(arm)的95%参考范围是19～35 mmHg。前臂血流阻断30 s、60 s时P(arm)与收缩压、舒张压、平均动脉压和中心静脉压呈正相关(30 s r值分别为0.653、0.735、0.733、0.523、P值均<0.001；60 s r值分别为0.654、0.764、0.750、0.564，P值均<0.001)，与心率和脉压差不相关。线性回归分析显示，前臂血流阻断10 s、20 s、30 s时P(arm)与舒张压呈线性相关(10 s：β＝0.504，P＝0.001；20 s：β＝0.297，P＝0.005；30 s：β＝0.231，P＝0.015)，而阻断40 s、50 s、60 s时P(arm)与舒张压(40 s：β＝0.220，P＝0.004；50 s：β＝0.210，P＝0.004；60 s：β＝0.213，P＝0.004)、中心静脉压(40 s：β＝0.516，P＝0.018；50 s：β＝0.513，P＝0.01；60 s：β＝0.472，P＝0.023)呈线性相关。 结论： P(arm)随着阻断血流时间的延长逐渐降低。前臂血流阻断30 s时P(arm)的参考范围为23～44 mmHg，阻断60 s时的参考范围为19～35 mmHg。P(arm)与动脉血压和中心静脉压相关。.
Keywords: Arm equilibrium pressure; Hemodynamics; Mean systemic filling pressure.